A climate of inclusion

National health blueprint finally recognizes gays

August 19, 2001|By Jane E. Allen. Special to the Tribune. Jane E. Allen is a staff writer for the Los Angeles Times, a Tribune newspaper.

Gays and lesbians are hailing their new inclusion in the national blueprint for good health but call it only a first step toward recognizing their unique needs.

The health agenda, called Healthy People 2010, is the third in a series of U.S. documents begun in the 1970s. Each established 10-year national goals for preventing illness and disability and increasing Americans' access to health services.

The newest version acknowledges for the first time that care for gay, lesbian, bisexual and transgender Americans involves more than AIDS treatment and prevention. The document points out that sexual orientation may account for disparities in finding a doctor, taking advantage of health services and receiving appropriate care.

The federal government included sexual orientation as a factor in 29 out of more than 400 health objectives. Those involve access to care, educational and community programs, HIV, immunization and infectious disease, injury and violence prevention, sexually transmitted disease and substance abuse.

But in most cases, the gay-lesbian-bisexual-transgender community was listed in data tables under the heading "Data Not Collected," which means the government still isn't tracking how those people are doing, said Gwenn A. Baldwin, executive director of the L.A. Gay & Lesbian Center.

"It's like somebody inviting you to a wedding, but there's no seat, no table and no food for you," Baldwin said. "I feel great about the invitation, but the promise of actually attending isn't there."

Further recognition

She said gay advocates' hopes for further federal recognition lie in a 500-page companion document released in May. That report, compiled by the Gay & Lesbian Medical Association with $50,000 from the Department of Health and Human Services, attempts to pinpoint the unique health needs of millions of Americans long overlooked by federal health surveys and programs.

What they now need, she said, is data that demonstrates to federal health officials where their needs aren't being met, which can only be done by including sexual orientation-questions in major federal health surveys.

Such questions would prove that sexuality is getting in the way of care and that gays and lesbians have unique health concerns. Without them, it also becomes difficult to obtain funding to address inequities and to measure progress in meeting Healthy People 2010's targets, said Judy Bradford, a Virginia Commonwealth University researcher who had a major role in compiling the companion document.

Smaller health studies have shown several areas in which gays, lesbians, bisexuals and transgender people have unmet needs, but there have been no large-scale studies.

For example, gay teens have been found five to six times more likely than straight teens to attempt suicide, and they're less likely to get information about sexually transmitted diseases and AIDS. Gay adults are disproportionately affected by mental health and drug problems. Gay women often forgo routine gynecological care because of fear of discrimination. Gay members of minority communities often don't get the primary care they need. Families headed by two men or two women, which are turning up in Census 2000, rarely have the spousal benefits extended to heterosexual families and thus often rely on separate health plans.

How to ask

One obstacle to obtaining good data stems from ongoing debates within the gay community and academic circles on how best to ask about sexual orientation. Some people may not identify themselves as homosexual or bisexual. The solution may require asking about sexual behavior or sexual attraction, not merely about orientation. For instance, Bradford said, when the National Health and Nutrition Examination Survey asked about sexual orientation beginning in 1998, it succeeded in identifying same-sex sexual behavior among whites and blacks. It failed to identify that activity among Latinos. The question was pulled from the survey in 2000, and Bradford expects it to be redesigned.

Already, some states are trying to compile such data. The California Health Interview Survey, a report card measuring the health of Californians every two years, last summer posed its first sexual-orientation question. And the state of Massachusetts recently became the first to add sexual-identity questions to youth risk-behavior surveys, Bradford said.

Given how difficult it's been to get attention at the federal level, gay advocates are reframing some of their requests for federal help and turning their attention to state and local arenas.

" `Do you want to fund a lesbian health project?' is probably not going to get as far as `I've got a substance abuse program that is going to reach a population that is six times more impacted by substance abuse than the average population,' " Baldwin said.

Advocates are also reaching into underserved racial communities. Said Baldwin: "It's necessary today to recognize the lesbian, gay, bisexual and transgender community is not monochromatic."